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Differential Diagnosis of Rash Illness






(10 day or hard measles)

3-4 days of fever higher that 101°F; red, watery eyes which are very sensitive to light; cough, runny nose, tired.

Red, raised, blotchy rash which begins on face and neck; spreads slowly downward, eventually reaching the legs and feet by the 7th day. By 5-6 days rash is brownish color, with occasional peeling appearance.

  • Highly contagious, airborne spread.

  • White spots can appear in the mouth, on the inside of the cheeks.

  • Rash usually does not itch.

* Immunization for prevention very important.


(3 day or German measles)

Children may have few or no early signs

Adults: 1-5 days of low-grade fever, headache, joint pains, runny nose, tired, red, watery eyes. Swollen glands in neck or behind ears.

Pink to red rash, beginning on head or neck and spreads downward, fades and disappears in 3 days. No peeling appearance.

  • Many infections are so mild they are unrecognized.

  • Serious concerns to pregnant women as it may cause birth defects, therefore

* Immunization for prevention very important.

Chicken pox

(Varicella Zoster virus)

Generally low- grade fever for 1-3 days, loss of appetite, headache.

Early rash appears like insect bites, random sites, progresses to red, raised lesions with a small blister in center. New lesions appear daily for several days. All stages of rash can appear at the same time. Lesions usually crust and scab within 5-10 days.

  • Lesions can appear on the scalp, in the mouth, ears, genital regions and armpits

  • Disease is spread by droplets in the air and by contact with the watery blisters.

Scarlet Fever

1-3 days feeling very tired, sore throat, fever, and vomiting.

Fine, bright, red rash that briefly turns white if you press on it. Most prominent on neck, in armpits, groin, or folds in the skin. Light peeling of skin on hands and feet. Sandpapery, rough feel to the rash.

  • Face can be flushed (red) with white ring around the mouth; tongue can swell and become coated with a “strawberry” appearance.

*Relationship of scarlet fever and rheumatic heart disease in untreated cases.

*Treatment with antibiotics

Fifth’s Disease (Parvovirus B19)

Brief, nonspecific illness consisting of fever, malaise, myalgias, and headache. Often spreads in epidemics among children.

Red, flushed cheeks, reddened face with white ring around the mouth, red lace-like rash on trunk and extremities. Lasting 7-9 days.

  • Sunlight makes rash worse.

  • Face has “slapped cheek” appearance.

  • May fade and recur for few weeks.


3-5 days of fever over 100°F, can have runny nose, tired.

Sudden, raised, smooth rash, which disappears in 24 to 48 hrs. Starts on trunk, can become total body rash.

  • Rash follows the fever

  • Generally, mild illness.

Enteroviral Rash e.g. Coxsackie virus, Hand, Foot and Mouth

Sudden onset of fever to 103°. Sore throat, cold-like symptoms, headache, tired, nausea, vomiting, diarrhea.

Red, raised rash, most on trunk and face, may appear on palms and soles. Rash may appear with blisters in mouth, fluid filled bumps on hands, feet. Rash lasts 1-10 days.

Several different disease syndromes may be present – common in children is Hand, Foot and Mouth disease.

Virus shed in stool, good handwashing important!






Rash appears as little pin sized “pimples” but evolves quickly into major skin eruptions filled with pus.

Begins as pin sized blisters that break, allowing the discharge to spread on the skin surface, causing skin breakdown. White or yellow crust form at the sites, can cover large areas if untreated.

  • Children often have this rash around the mouth particularly under the nose and chin.

  • Impetigo “itches”

  • Handwashing important

  • Treatment with antibiotics

*Heat Rash*

(Prickly heat)

Often appears in moist skin folds of legs, arms, & neck; also at waistline and on buttocks

Bands or reddened areas or patches of reddened areas.

  • Heat rash is a result of hot, humid weather conditions and the skin contact with itself, diapers or clothing. Most often associated with plastic diaper pants or disposable diaper plastic irritating the skin surface and increasing stimulus of sweat glands.

Diaper Rash

Reddened skin on buttocks, or “diaper area” as a result of irritation or infection from stool, urine or prolonged skin contact with plastic diapering materials. Develops in moist areas.

Rash can be generalized reddened skin surface, evolving to blistered appearance and skin breakdown, with inflamed, moist and bleeding patches. This rash causes discomfort and pain.

“ Diaper rash” can be caused by prolonged contact with soiled diapers; however, some viral or fungal organisms may cause sores and blistering appearance.

Drug or food reaction

Occasionally fever, red, runny eyes, sores in the mouth, genital regions, and asthma like symptoms to extreme difficulty breathing.

Rash may appear as raised skin areas like “welts” or as “hives” in a cluster. Itching usually present. Rash may appear quickly, may be isolated areas to a complete body rash.

  • Discuss introduction of medicines or new foods to prevent further illness.

  • Can appear quickly and be serious. (This rash appears for no other apparent reason.)


Fever for 2-4 days before rash, extremely ill.

Rash starts with small bumps on face and upper arms, then spreads over the whole body, more concentrated on extremities and face. The lesions become blistered, then filled with pus, then scab over.

  • Rash is most often confused with early chickenpox

  • Fever and severe illness for several days before rash onset suggests smallpox and not chickenpox.

Adapted from Communicable Disease Flip Chart, K. Ford and K. Liberante, Maricopa County Department of Public Health and Pima County Health Department, 1994.

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